Admin (12)

What is a premium?

A premium is the monthly cost of the benefit plan to the employer.

What is co-payment?

It is the portion of the expense that is not covered by the benefit plan. For instance, if a benefit plan has drugs reimbursed at 80%, then the remaining 20% would be the co-pay.

What is a deductible?

A deductible is an agreed amount that must be paid by an insured person making a claim against an insurance policy before an insurer will pay any compensation.

Who is eligible to be covered under the plan?

Partners/spouses, children (covered up to a certain age). Many plans have stipulations that must be met to define eligibility, such as: must be a Canadian resident, must be under age 65, must have active provincial health coverage in place.

How do I enroll new staff in the plan?

You must have the employee complete an “employee application” form and submit it to your respective carrier within 30 days of the employee becoming eligible for benefits. An employee becomes eligible for benefits once they have completed the wait period; the average wait period is approximately 3 months. Applications received after that time frame may be considered a late applicant and the employee will be required to complete medical evidence before being considered for benefits. Please check your policy to learn about your wait period and contact our office if you have any questions or trouble locating the correct forms.

Is there a waiting period before coverage kicks in?

Typically, the average wait period is 3 months from the date of the first day of full-time employment.

Is waiving the waiting period an option?

At the discretion of the employer, it is possible to request that the waiting period for a new employee be waived if it is a condition of hire.

What is a late applicant and how do I minimize this from happening?

If the employee is not enrolled in a group program within 30 days of their eligible start date for benefits, they are considered a late applicant. If an employee is deemed a late applicant, then the employer will have to direct the employee to provide the carrier with a full medical history disclosure and reduced benefits will be applied to the late entrant. The carrier also reserves the right to deny the employee outright and refuse them coverage.

Can my children and spouse be covered?

Most plans require you to provide coverage for your family and dependents. Additionally, plans generally allow children to be covered up to age 21, or age 25 if they are a full time student. If your child has a physical or mental disability, they might be eligible for longer coverage – please contact Unison or your group plan administrator for your employer for further information. Your group booklet will contain more details about dependent child and spousal requirements.

What if my spouse/partner has a plan already, what then?

There are a couple of different options available to you in this situation. Regardless of your decision, you will have to be enrolled into the plan at the time you become eligible to avoid being labelled a late applicant.

  • You can each take full benefits and coordinate benefits with your spouse. Coordination is especially useful for benefit areas which enforce annual or lifetime maximums.
  • You take coverage under your plan and your spouse waives his health/dental benefits.
  • You take coverage under your spouse’s plan and you waive your health/dental benefits.

If you choose to waive benefits, you can only opt back into the plan if your spouse loses their benefits. You have 30 days to notify the carrier of the change. If you do not adequately enroll into the plan (because you are waiving, etc) but require benefits after you pass your eligibility date, you’ll be considered a late applicant. Late applicants have to submit medical evidence to prove their health status and the insurer can choose to deny coverage.

What is a coordination of benefits and how does it work?

Coordination of benefits is useful when two working members of a family each have a plan, providing greater security and coverage for dependent family members through the combined coverage of two plans. This is especially useful for benefit areas which enforce annual or lifetime maximums.
Here are some useful tips:

  • Your plan is your primary insurer and your spouse’s plan is the secondary insurer. Claims for yourself go through your plan first and then any outstanding amounts are submitted to the secondary insurer. Claims for your spouse are submitted to their insurer first and then any outstanding amount is submitted to your insurance.
  • If you are claiming expenses for your children, the primary insurer for the children is decided by the parent with the earliest birthday (month and day) in the calendar year. For example, if your birthday is February and your husband’s birthday is November, then the children’s expenses must run through your plan first.

Are insurance premiums tax deductible?

Some insurance premiums are tax deductible.

Claims (2)

Where do I submit my claim?

Claims can be submitted by fax or mailed to the carrier. Also, most carriers have a member website or mobile app that allows for online claim submission.

Our ASO clients can fax, mail, email or drop off their claims. They can also register for Unison’s online claims access in order to submit claims online and through our mobile app for smart phones.

How far back does my claim allow me to file?

Most carriers will accept claims from the previous 12-15 months, but it varies. Please contact your carrier for clarification.

Coverage (10)

What percentage of my employees have to be enrolled in a group plan?

Most plans are mandatory participation plans, which means all of your employees must enroll in the plan (but can waive health/dental benefits if they have coverage through a spouse or other job/situation). In non-mandatory plans, most carriers require at least 75% of the employees to enroll if it’s a larger company and 100% of employees if the company is small.

What is the minimum number of employees an employer needs to qualify for a group plan?

We can offer group employee benefit plans to all different sizes of businesses, even just 1 person companies.

How much of the total premium do I have to contribute to the group plan?

While it is the employer’s decision to decide how much the employees must pay, most carriers require the employer to pay at least 50% of the premium. It is important to have the employee pay the premium for their disability benefits to ensure it would remain a tax free benefit to the employee.

Why would I need a group benefit plan?

Employee benefit plans promote wellness and help employees afford the tools necessary for them to maintain their best health. Healthy employees mean more productive, motivated and focused employees with less absenteeism.

Should I get a plan that comes with life and disability benefits?

Group insurance plans can be augmented with affordable life insurance and both long term or short term disability. Certain employee benefit plans require a small amount of life insurance as part of the policy but disability benefits are usually optional. Additional or enhanced life insurance can also be added to most policies. Disability insurance may be added to the plan as a weekly or monthly benefit, or both, in order to cover both short and long term disabilities.

What is critical illness insurance?

Critical illness insurance pays out a lump sum in the case of the diagnosis of an eligible major illness. For example, in the event of heart attack, stroke, cancer, bypass surgery, and multiple other illnesses, the employee would receive a payment of cash, tax free. It can be offered on a group basis so that no medical evidence would be required. Additionally, most plans can be converted to individual policies should the individual leave the group.

What is disability insurance?

This insurance covers employees in the event of injury or illness that prevents them from working. If an employee is off for an extended period of time, disability insurance pays the employee a stipend. This allows the employee to pay for their bills and allows the employer to pay for a replacement worker, if necessary. It is imperative that employees pay the premium for their STD/LTD coverage as then the benefit could be paid out tax free; if the employer pays the premium, the benefit would be taxed as if it were income. There are two categories for this type of insurance:

  • Short Term Disability (STD) is meant to cover employees on a short term basis, to help bridge the gap while employees wait for long term disability. Short term disability is especially helpful for people who cannot qualify for EI benefits, like business owners. Similarly, if a plan has short term disability coverage in place, then the business can apply for an EI rebate to help offset the cost.
  • Long Term Disability (LTD) covers long term illness and disability. The standard wait period is approximately 3 months from the date of disability and employees receive an average of 66.6% of their salary.

What is cost plus?

Cost plus can be used as a stand alone benefit, but is more often used to supplement group benefit plans. It allows for additional reimbursement when the maximum amount of coverage is reached, exceeded or involves items and procedures not covered under the group plan.

Cost plus options save tax dollars for you and your company and takes advantage of non-taxable employee benefits. Essentially, it takes a personal expense and turns it into a business expense. The employee collects their receipts for any expense eligible as listed under the Canadian Income Tax Act and fills out an expense form. The employer sends the receipts, expense form and a cheque totaling the employee’s expenses plus a small administration fee to our office for processing. The plan then reimburses the employee and the employer gets to write off the amount as a tax deductible benefit expense.

Am I covered for travel and emergency medical coverage?

The health benefit of employee benefit plans often include travel and emergency medical insurance, but you should always check your insurance before you travel to ensure it’s active and up to date. Don’t forget to read your benefit booklet and fully understand the coverage, limitations and clauses regarding stability periods!

I currently have a group benefit plan for my employees. Can the plan be cancelled?

The carrier cannot cancel the plan if you are meeting their contract requirements and paying the monthly premiums in a timely fashion. You can cancel your own plan but are required to give at least 30 days notice. However, a benefit plan is often considered a contract to your employee and should only be cancelled after careful consideration and consultation with professionals. Please contact Unison Benefits if you would like to review your plan.

Quoting (2)

What form(s) or information do I need to provide to request a quote?

Generally we require a completed employee census, your benefit booklet, your claims history/previous renewals and your most recent billing statement. We can provide you with the form for the employee census and assist you with the collection of the data. Please contact our company for specifics.

How long does it take for Unison Benefits to provide a comparative analysis of my benefits?

  • We meet with you to discuss your needs and are provided all relevant information about your group.
  • We submit all available information to various carriers.
  • Unison analyzes all information provided by the carriers.
  • We discuss the resulting information with you and make recommendations.

Retirement Planning (3)

What type of defined benefit plans are available?

  • Career Average Pension Plan
  • Best Earnings Plan
  • Final Earnings Plan
  • Flat Benefit Plan

What types of pension plans are available to employers?

  • Defined Benefit Plan – monthly pension contributions are determined by a formula. It’s the employer’s responsibility to invest contributions and to ensure funds are available when employees retire.
  • Defined Contribution Plan – the employer and employee each contribute a set amount to the plan, usually a certain percentage off each cheque. Employee pension amounts will be determined on the amount accumulated after retirement.

What is a group RRSP?

The employer deducts the employees contribution to the group RRSP off each cheque and the amount is deposited into an RRSP account.